Q: How Do You Fix an IT Band Injury?
Hey Lauren,
How do you fix an IT Band injury?
Bryna
A:
Bryna,
Mine has been a problem since October, so I don’t know if you want my advice. Andrea, a fellow runner I talked to today, told me something that resonated: “Unlike other injuries, IT bands and achilles tendons are on their own agendas.” True dat. They seem to want to heal in their own time. The best treatment is prevention, so to everyone else out there, get on your rollers! Otherwise, people are writing helpful comments and their own experiences with IT Bands on my latest blog post here so check that out.
I would say that deep tissue massage to the glutes, TFL and quads, rolling on a foam roller, and strengthening exercises for the glutes tend to be the most common fixes among people who I’ve talked to. In Eugene, Chance Fitzpatrick is a good resource for specific deep tissue, but I don’t know where you live.
When it comes to figuring out how much to run and when, and what specific things to do to make it better, it can be maddeningly confusing. I’ll have to write more in the comments when I solve this problem, but for now I’ll leave you with this: This video is what it feels like to work with an IT band injury:
(Special thanks to ALF reader and blogger MBS for reminding me of this scene from Forgetting Sarah Marshall).
Lauren
Lauren: Wow! That was quite a blog. Know right where you’re coming from.
Anyway, here’s my thought on source and solution: I’m sure you know that the IT Band and the Achilles Tendon are both tendenous material with lousy blood circulation, so trauma to either takes forever to heal. That’s the bad news. HOWEVER I’ve found more often than not that, since tendenous material attaches to muscular material or bone at either end, more often than not Achilles & ITB issues originate elsewhere (that is to say in the muscle).
The ITB connects the gluteus maximus and the tensor fascia lata at the top, crosses the hip joint, goes down the outside of the femur, then crosses the knee joint and attaches to the Gerdy’s tubercle on the lateral aspect of the tibia. So it’s a big band of fiber which the GM muscle uses to abduct the hip and to flex the knee. A sure place for irritation in the ITB is where it pops back and forth over the distal lateral condyle of the femur as the tibia moves forward and back (as in sprinting or X-C or fast track work). Another place for ITB pain is in the hip where the tensor facia lata (which attaches to the iliac crest) pops back and forth over the greater trochanter of the femur (your ‘hip bone’). The tensor facia lata and the gluteus maximus work together. So excessive flexion or extension of the lower leg is one cause of ITB (and knee) pain, and excessive adduction/abduction is another. Which is to say fast running on uneven surfaces can certainly be an irritant. Rolling the belly of the ITB probably won’t do a damn thing to help, either. Rolling the GM & hip, if the muscle isn’t too irritated, can help. If this thing has progressed to muscle damage, then no soap.
OK: enuf with the physiology. I haven’t noticed you specifying whether the bum knee and the duff ITB are on the same leg, but I’m betting they are. I’m also betting they’re closely related: a buggered IT tendon at the knee swelling up (or maybe tensing up) and somehow yanking the knee out of slignment. Won’t take much. I’m also betting I can guess how it started. You even showed us all a picture of it on your blog last fall. Remember the photo you put into one of your marathon prep articles of you blasting down the auto road at Crater Lake? Look at how your lead leg is straight out in front of you, knee fully extended, about to slam down and act as a brake. Made me cringe just looking at it. I even commented to my wife at the time: ‘Hooboy; she’s askin’ for it!’ (I’ve run that damn road, so I know how steep it is!) The ITB is fully extended and tense, so the impact goes straight into the band and up to your glutes. The quads help too, of course, but the main impact goes right up the ITB. Any slight misalignment, even in foot plant, and kerblammo.
So what? So it’s a “muscle thing” I’d bet money. Solve one (the ITB) and you’ll likely solve the other (the knee). How? RICE, maybe ultrasound, maybe Dr. Ball’s magic. And certainly EZ running on grass when you start up again: nice straight posture, no big loads on glutes, certainly no sprinting. To be safe, I’d suggest RICEing both ends of the ITB just to be sure: hip from the top of the ishium down past the GM, AND the lateral side of the knee.
OH: and forget the damn Olympics! Sounds dumb, but now is the time to remember why you love running: what got you hooked on it back in 8th grade. Just the grass flowing beneath your feet and the breeze in your hair is enough. If you can feel that for just thirty seconds or a minute, it was a good day: go home and RICE some more. Have Doc Ball fiddle with your cables and rods and hinges again. Tomorrow, go out and enjoy your fabulous free gift again. Repeat as often as needed. It’ll come: you know it will. If it’s two months after the Olympics, who the hell cares? I mean really…
Luck: CYa.
Hi Lauren, I recently found your blog via my friend Dave/Pacer/Dooder/Suffer Seeker. And I’ve so enjoyed reading!
I was out with IT band syndrome for 8 months in 2008. I immediately went to PT and started glute medius etc. strengthening, daily rolling, and stopped running and cycling. It didn’t get better. Every few weeks I would try to run again to no avail. I’m a big fan of traditional western medicine, but I reached a point where I was closing in on Kona with zero bike/run training, so I tried a chiropractor and ART. The chiropractor told me to back away from the foam roller. She made me quit swimming, saying kicking and pushing off the wall wasn’t helping. She worked on me every couple of days. I was back to running regularly within two weeks, managed a 6-wk Kona build, and had a decent race.
Even now, if I use a foam roller, I will fall right back into a sore IT band. If I do lunges, same thing. I guess different strokes for different folks, and all. I know you have great resources and drs and chiros, but I just wanted to share what finally got me well and running again.
Hope you’re 100% soon!
rachel
Just found this blog and am sorry to hear about your struggles. I’m sure you’ve heard the story 10 times over (and in ten slightly different ways) from doctors and physical therapists, but one thing I’ve noticed missing from the explanations for IT band pain offered by readers here is the importance of hip abductor and external rotator strength. It turns out that many runners with IT band problems have weaker hip abductors and external rotators than runners who stay healthy. Perhaps not surprisingly, many runners who develop IT band syndrome also have increased internal rotation and adduction of the hip when they run—the two movements the abductor/external rotator muscles are supposed to control! I write an occasional blog on (among other things) synthesizing scientific research as it relates to running injuries, and I just happened to recently blog about ITBS.
http://runningwritings.blogspot.com/2012/02/injury-series-biomechanical-solutions.html
While I don’t think hip strength will be the solution for everyone (and it doesn’t sound like that’s been the case for you—I definitely sympathize with having ‘a binder full of exercises’), it deserves mention as an important causative factor for many people.
Best of luck,
-John
Lauren,
Have any of your doctors/specialists said anything about the way your foot lands? Today a random stranger told me that my left foot turns in too much when I land/take off. Like you, I’ve had both a navicular stress fracture and an ITband injury, (all on my left side,) so I was curious to see if you had any biomechanical problems like that.
Thanks!
-Mandy
Hey Lauren – really bummed about your ITB (mine as well!). In addition to all you’ve been doing, I’d also recommend complimentary work using the Feldenkrais method to help you change whatever habit you’ve developed that makes the injury recur. This is a very gentle process that works for runners of all abilities including professionals (http://racingnews.runnersworld.com/2011/05/a-brief-chat-with-jen-rhines-6.html). I can highly recommend the person who worked with Jen – she can work with you over skype so you wouldn’t even need to leave your home. Please feel free to contact me if you would like to hear more.
All the best – Jo Ann
I have read many of the articles around your struggles with the injury and your chances or making the Olympics.
Whether you make the Olympics or not, you are one of the great runners of our generation. You will always be great and an inspiration to many runners. Please don’t ever forget that. Good luck in all you do Lauren!
ITB is the most frustrating injury. I’ve been fighting mine for over a year. At first I tried really hard to stay with everything, but now I’ve basically given up on running for the indefinite future. I haven’t run in months. It’s so sad and depressing. I still cycle a lot, but I feel like there’s a dark cloud always in the background, the dark cloud of the fact that I have no way forward to fix this, I can’ afford the one therapy my doctor recommended, and I already burned through all of the generic physical therapy that my insurance will cover. I tried foam rolling and PT exercises so many times, to no avail. Maybe I will try the chiropractor and ART, like someone above suggested. If I can get my insurance to cover it.
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Hi
I’m a swinner that has had IT band problems off and on for over two years and while it might go away occasionally it always flares up again. I have been to podiatrist and a physiotherapist and have done every stretch possible to build up the other muscles around my knee and legs. I was wondering if anyone has any suggestions on what to do next because this problem is really taking over my life.
Thanks